In 2010, the World Health Organization established the Global Network for Age-friendly Cities and Communities. Harriet Pike reports from pharmacies in a couple of these cities
When one of Ken Agravat’s customers came into his pharmacy to ask for his wife’s medicines, the community pharmacist from Manchester, in the UK, knew something was amiss. The medicines had been delivered to the patient earlier in the week and the elderly man seemed confused. Mr Agravat visited the couple at their home, where he spotted several bags of unopened medicines under a chair. “I collected two bin bags of medicines that hadn’t been used,” says Mr Agravat, who then arranged for the couple’s medicines to be supplied in seven-day monitored dosage system (MDS) trays.
Providing medicines in compliance aids is just one of the services pharmacies can offer elderly patients who might be struggling with poor dexterity, sight or hearing, or who are confused. A delivery service for housebound patients can be a lifeline: “We use coloured tags on [medicines] bags, so delivery drivers know which customers need extra support,” explains Mr Agravat. “Drivers will ask these customers additional questions — even checking that they have heating or if they need any shopping.” His pharmacy’s layout is important too — ramps and handrails improve access. “We have wider aisles so customers can drive their scooters into the pharmacy and we have installed a buzzer at the entrance — so customers or taxi drivers can ring for help,” says Mr Agravat.
Manchester is one of an increasing number of cities worldwide to have committed to creating age-friendly environments as part of the World Health Organization’s Global Network for Age-friendly Cities and Communities. The network was established to connect cities, communities and organisations worldwide with the common vision of making their community a great place to grow old in. It includes 541 cities and communities in 37 countries. While pharmacies have long provided age-friendly services, the network is helping to connect communities and spread good practice.
Like many community pharmacists, Mr Agravat offers medicines use reviews to older people and uses the opportunity to check whether they have any medication or social support needs. Pharmacy staff then offer appropriate assistance or signpost customers to social support groups. Alongside this signposting service, Mr Agravat regularly visits groups and day centres for older people, where he offers healthy living advice, including advice on staying active, social support, tackling isolation and chair-based exercise.
In Duleek, Ireland, community pharmacist Kathy Maher sees outreach work as integral to pharmacy’s role. Working closely with local groups gives pharmacists the chance to encourage participation in seasonal vaccination, discuss medicines and talk around topics such as falls, hypertension, cholesterol and heart health, osteoporosis and memory.
Ms Maher’s pharmacy is accredited under a national programme that recognises pharmacies that deliver a literacy-friendly service (see Box 1). Staff engage with the programme to enhance how they interact with customers. “This encourages us to make dispensing labels clearer and easier to use, to ensure we communicate clearly with older folk and check that they have understood any information or instruction by asking them to repeat back what we have said,” explains Ms Maher.
Clear communication and staff training are central to pharmacy manager Mo Alam’s drive to create an age-friendly pharmacy in Prestwich, Greater Manchester. In addition to MDS trays, Mr Alam’s pharmacy can provide large print labels, medication reminder and description charts, and easy-open bottles. The pharmacy has also adapted its managed repeat system to prompt staff to check and order medicines for patients with memory issues. All patient-facing staff are trained to recognise vulnerable adults and understand how to report their concerns. In-house training equips staff to carry out pharmacy-related disability assessments. And all staff, including drivers, undertake dementia training, offered through the Dementia Friends initiative (see Box 1) run by the Alzheimer’s Society, a UK charity.
Pharmacists wanting to support older people can also offer age-friendly health checks and public health information; keep catalogues for mobility aids and signpost to reputable suppliers; collect contact details of relatives and carers; flag changes to medication (ie, brand, packaging); consider where products are located on shelves; and ensure websites are user-friendly for everyone.
Low noise levels, clear signage and a clutter-free, well-lit environment help older customers navigate Mr Alam’s pharmacy. Hard-of-hearing patients have access to a loop system, the pharmacy’s consultation room doubles up as a quiet room, and there is comfortable seating. “These meet the physical needs of the patients but my staff’s friendly smiles, willingness to help and accommodate the needs of patients is our biggest asset,” says Mr Alam. “The staff are trained not to make assumptions and to be extremely tolerant.”
Elsewhere in Manchester, Mr Agravat is converting the basement of his pharmacy into additional consulting rooms, with space to hold coffee mornings. “We take an interest in the well-being of our elderly customers and try to spend time with them,” he says. “They come because they are lonely and want to talk. If they are experiencing difficulties, we try to resolve them.”
Simple and logical criteria
Miguel Angel Gastelurrutia is a community pharmacist in San Sebastian, one of the first Spanish cities to sign up to the WHO’s age-friendly cities initiative. He has been involved in research exploring the characteristics of an age-friendly pharmacy, the findings of which have been published in the International Journal of Pharmacy Practice.1 The researchers conclude that to characterise a pharmacy as “age-friendly”, 15 commitments need to be adopted, falling into four main areas: relationships, pharmacy layout, pharmaceutical services and communication of services (see Box 2). Mr Gastelurrutia suggests that pharmacists wanting to create an age-friendly environment adapt the 15 criteria to their particular setting. Elderly customers want empathic treatment, with respect and privacy, explains Mr Gastelurrutia. They want easy access to the pharmacy and a place to sit down in waiting areas; they want the pharmacy to have enough stock of medicines and to coordinate with the nearest health centre and social services. Ultimately, he concludes, what people need and expect from an agefriendly pharmacy is simple and logical.